Go to the Federal Communications Commission homepage at www.fcc.gov

FCC Form 399: Reimbursement Request

Approved by OMB 3060-1178
Go to the Federal Communications Commission homepage at www.fcc.gov

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Facility ID:
168335
Service:
LPD
Call Sign:
KPVM-LD
Channel:
25 (UHF)
File Number:
0000089828
FRN:
0006015465
Eligibility Status:
Eligible
Date Submitted:
11/14/2019

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KPVM TELEVISION, INC.

Doing Business As: KPVM TELEVISION, INC.

890 S. HIGLEY

PAHRUMP, NV 89041

United States

+1 (775) 727-9400 videovern@kpvm.tv Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

Back to Top

Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

Back to Top
Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan KPVM Ch 46 displaced into the core and T-Mobile Oct 2018 off ch 46.

Transmitters

Back to Top
Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Primary Transmitter

Back to Top

Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? No
Existing Transmitter Manufacturer and Type Manufacturer
Model 1
Year 2017
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 kW

Primary Transmitter

Back to Top

New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model BE-TV1k2-FA-U
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter Old transmitter could not be retuned from Ch 46 to Ch 25.

Primary Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? Yes
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service No
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

Back to Top

Other Transmitter Cost Not Listed

Name Description

Interim Facility

due to T-Mobile shut down.

Antennas

Back to Top
Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

Back to Top

Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? No
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 10.7 kW
Manufacturer
Model PSILP
Year 2017

Primary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Other Antenna Type PR-TV Array
ERP: 13.0 kW
Manufacturer
Model PR-450 Array
Year 2018
Justification for New Antenna Displaced channel required directional array at new location to avoid interference.

Primary Antenna

Back to Top

Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Interim Facility

Temporary antenna due to coverage issues related to STA to operate while coordinating CP buildout.

Transmission Line

Back to Top
Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? Yes

Primary Transmission Line

Back to Top

Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? No
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 220 feet per run

Primary Transmission Line

Back to Top

New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 250 feet per run
Justification for New Transmission Line New line required to construction of CP at new location.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? Yes

Primary Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

Back to Top
Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Primary (Main)
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? No
Coordinates (NAD83) Latitude (NAD83) 36° 12' 24.8" N-
Longitude (NAD83) 115° 57' 38.0" W-
Overall Structure Height 194.00 feet
Support Structure Height 194.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 2871.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner KPVM
Date Constructed 01/01/2007


Primary Tower

Back to Top

Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Name Description

STA installation

tower rigging for STA and trouble shooting cable / antenna problem

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? No
Outside RF consulting Engineering Services Perform engineering study for displacement application Yes
Prepare engineering section of Form FCC Construction Permit Application No
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 3
Prepare Form 601 No
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application No
Prepare and file Form FCC License to Cover Application No
Prepare request for Special Temporary Authority No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Back to Top
Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
Does this relocation require Equipment Storage? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

Back to Top

Other Expenses Not Listed

Name Description

Misc

STA associated interim expenses

Cost Information

Back to Top

Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $101,463.70 $90,739.46 N/A $6,638.70 N/A
Total for all systems $233,243.61 $149,466.76 N/A $36,593.94 N/A
Primary Transmitter BE-TV1k2-FA-U $101,463.70 $90,739.46 $6,638.70
Interim Facility $7,463.70 $7,463.70 Gapinski etc $6,638.70 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $73,275.76 42463.26 BE Transmitter Quote 30812.5 encoder N/A N/A
Transmitter Building Site Survey/Installation $10,000.00 $10,000.00 Cost catalog N/A N/A

Components

Actual Information Description File Name
Interim Facility

Component Description:
anywave tech support
Amount:
$300.00

Component Description:
interim xmtr
Amount:
$1,818.40

Component Description:
interim xmtr
Amount:
$425.00

Component Description:
Digital Exciter for interim xmtr
Amount:
$2,980.00

Component Description:
Interim xmtr shipping
Amount:
$35.68

Component Description:
Interim xmtr shipping
Amount:
$93.37

Component Description:
shipping interim xmtr
Amount:
$36.25

Component Description:
Interim xmtr
Amount:
$600.00

Component Description:
Interim xmtr repair
Amount:
$300.00

Component Description:
Interim xmtr repair
Amount:
$50.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW Information not provided.
Transmitter Building Site Survey/Installation Information not provided.

Cost Information

Back to Top

Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $20,917.10 $11,785.41 N/A $11,675.24 N/A
Total for all systems $233,243.61 $149,466.76 N/A $36,593.94 N/A
Primary Antenna PR-450 Array $20,917.10 $11,785.41 $11,675.24
Interim Facility $3,475.01 $3,475.01 ERI AL8 . $3369.10 . See ERI Quote Tessco 105.91 $3,365.34 N/A
Sweep test of transmission line and antenna $5,730.00 $500.00 500 Todd Comm 12/31/18 $500.00 N/A
Side Mount antenna brackets $4,625.00 $723.31 18.76 Autozone misc parts 112.75 H & H Pipe misc parts 591.80 Patterson Fabrication $722.81 N/A
UHF-Low Power, Side Mount, Other, 13.0kW input, Horizontal $7,087.09 $7,087.09 PRTV Array . BWS Inv 5931 $7,087.09 N/A

Components

Actual Information Description File Name
Interim Facility

Component Description:
STA Interim operation
Amount:
$3,256.43

Component Description:
jumpers
Amount:
$108.91
Sweep test of transmission line and antenna

Component Description:
Sweep line coverage issues
Amount:
$500.00
Side Mount antenna brackets

Component Description:
misc tower
Amount:
$112.75

Component Description:
misc socket
Amount:
$18.26

Component Description:
brackets
Amount:
$591.80
UHF-Low Power, Side Mount, Other, 13.0kW input, Horizontal

Component Description:
PRTV Array Antenna
Amount:
$7,087.09

Cost Information

Back to Top

Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $14,612.31 $11,493.89 N/A $0.00 N/A
Total for all systems $233,243.61 $149,466.76 N/A $36,593.94 N/A
Primary Transmission Line $14,612.31 $11,493.89 $0.00
Flexible Foam Transmission Line - dielectric, 1 5/8" $6,000.00 $2,881.58 2881.58 250 ft Eupen N/A N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $8,612.31 $8,612.31 BE Sales Order A600274 N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $69,040.00 $14,050.00 N/A $14,050.00 N/A
Total for all systems $233,243.61 $149,466.76 N/A $36,593.94 N/A
Primary Tower TOWER $69,040.00 $14,050.00 $14,050.00
STA installation $12,850.00 $12,850.00 1800 Errett 1800 21 Century 1800 Donovan 750 Cooley 300 Glazener 300 Donovan 200 Errett 200 Donovan 600 21 Century Remove 600 Donovan 600 Errett 1200 21 Century AL8 1200 Donovan 1200 ERRETT $12,850.00 N/A
Tower Rigging Short Tower (less than 500') $56,190.00 $1,200.00 300 21 Century 150 Donovan 750 21 Century $1,200.00 N/A

Components

Actual Information Description File Name
STA installation

Component Description:
STA interim operation
Amount:
$1,200.00

Component Description:
STA interim operation
Amount:
$1,200.00

Component Description:
STA interim operations
Amount:
$1,200.00

Component Description:
STA interim operation
Amount:
$600.00

Component Description:
STA interim operation
Amount:
$600.00

Component Description:
STA interim operations
Amount:
$600.00

Component Description:
STA interim operation
Amount:
$200.00

Component Description:
STA interim operation
Amount:
$200.00

Component Description:
STA interim operation
Amount:
$600.00

Component Description:
STA interim operation
Amount:
$300.00

Component Description:
STA interim operation
Amount:
$750.00

Component Description:
STA interim operation
Amount:
$1,800.00

Component Description:
STA Interim operation
Amount:
$1,800.00

Component Description:
STA Interim install
Amount:
$1,800.00
Tower Rigging Short Tower (less than 500')

Component Description:
Site Survey
Amount:
$750.00

Component Description:
Potosi site survey
Amount:
$150.00

Component Description:
Potosi
Amount:
$300.00

Cost Information

Back to Top

Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $9,402.50 $3,870.00 N/A $3,870.00 N/A
Total for all systems $233,243.61 $149,466.76 N/A $36,593.94 N/A
Outside Professional Services $9,402.50 $3,870.00 $3,870.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $60.00 BWS Inv 6233 $60.00 N/A
Prepare request for Special Temporary Authorization $3,840.00 $200.00 100 5896 50 6068 50 6138 $200.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A $1,710.00 N/A
Form 399 assistance or other Program Management costs $1,000.00 $1,000.00 BWS Eligibility 1876 preparation / submission See BWS Inv 6214 & Estimate $1,000.00 N/A
Perform engineering study for displacement application $1,800.00 $900.00 450 BWS 5896 450 BWS 6101 $900.00 N/A

Components

Actual Information Description File Name
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
fee for filing license to cover cp
Amount:
$60.00
Prepare request for Special Temporary Authorization

Component Description:
STA application
Amount:
$100.00

Component Description:
STA extension
Amount:
$50.00

Component Description:
STA extension
Amount:
$50.00
Prepare/ Review 399 reimbursement form

Component Description:
399 Reimbursement Preparation and Filing
Amount:
$1,710.00
Form 399 assistance or other Program Management costs

Component Description:
Eligibility & 1876 filing and preparation
Amount:
$1,000.00
Perform engineering study for displacement application

Component Description:
Engineering coverage issues interim facility
Amount:
$450.00

Component Description:
Displacement Engineering
Amount:
$450.00

Cost Information

Back to Top

Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $17,808.00 $17,528.00 N/A $360.00 N/A
Total for all systems $233,243.61 $149,466.76 N/A $36,593.94 N/A
Other Expenses $17,808.00 $17,528.00 $360.00
Misc $17,168.00 $17,168.00 REcap Rebranding Expense N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $190.00 BWS 5876 $190.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $170.00 BWS Inv 6233 $170.00 N/A

Components

Actual Information Description File Name
Misc Information not provided.
FCC Filing Fees - Special Temporary Authorization request

Component Description:
STA Fee
Amount:
$190.00
FCC Filing Fees - Form 2100 license to cover application

Component Description:
FCC Filing Fee
Amount:
$170.00

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $233,243.61 $149,466.76 $36,593.94

Reimbursement Status

Back to Top
Question Response
The facility has ceased operating on its pre-auction channel. Yes
Construction of final facilities or all necessary modifications are complete. No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

Back to Top
Section Question Response
Submission of Estimated Expenses Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  3. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

  7. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Vernon VanWinkle

President


11/14/2019

Certification

Back to Top
Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

  3. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  4. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  5. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

  6. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  7. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

  8. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  9. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Vernon VanWinkle

President


11/14/2019

Attachments

Back to Top